asc management
We Take Two Big Steps Forward
Filling the key position of nurse administrator and creating operational manuals are major hurdles.

By Larry Patterson, M.D., and Ray Mays

In this month's article, I'll cover our search for a nurse administrator and discuss the time and effort involved in creating your ASC operational manuals.

We approached the search for a nurse administrator with an arrogant confidence that probably bordered on offensive. We initially assumed that we would run an ad in the local paper and nurses from far and wide would beat a path to our door. We ran our first ad for 2 weeks and received one resume, and that person didn't meet even the minimum requirements we had specified in the ad.

We Make a Key Hire

Somewhat humbled, we ran the ad in more area papers, but again only heard from unqualified applicants. We then resorted to networking with other nurses, and finally obtained a pool of three qualified applicants to choose from. At this point, we had Dawn Cavanaugh (our ASC consultant) conduct in-depth interviews with each of the applicants to narrow our search to two individuals. In the end, we chose the nurse who had the most management experience.

The nurse administrator is inundated with responsibility from the first day on the job. Our nurse began approximately 90 days prior to our anticipated State and Medicare inspections. We should have hired her at the 120-day mark to make our lives a lot less hectic.

The nurse administrator must be organized and flexible. In addition to creating the ASC policies and procedures (more in a moment), the nurse administrator must interview and hire staff, organize and supervise staff in-service days, order equipment and supplies, deal with manufacturers' reps, and in our case, learn something about ophthalmology.

Take Time to Create Manuals

The ASC policies and procedures manuals must be created from scratch. I highly recommend purchasing a template. The templates are expensive, and in the beginning it's hard to justify the purchase. But save yourself the time and effort of trying to create them on your own. You'll thank me later.

The manuals cover every aspect of operating your ASC. Many of the required topics, such as handling bomb threats and fire drills, may seem irrelevant, but having now gone through it, I believe that we offer a better level of care because of these seemingly meaningless exercises.

Your ASC consultant will really earn her money during this phase, but you can't just delegate manual-writing to a consultant, or to an administrator. Doctors: You must invest a great deal of time and become deeply involved in the writing of the manuals. The manuals cover numerous key administrative and operational issues.

You must create a set of medical staff by-laws to the same level of detail that your hospital uses for its medical staff. You must create a step-by-step guide for hiring and firing employees. You must also establish committees (infection control, peer review, quality control), even if you'll be the only surgeon using the ASC.

Be prepared to spend at least 6 weeks writing and tweaking the manuals. Make sure that the procedures that you put in place are followed to the letter. Your center will be licensed and held to the standards that you create. It's hard to argue with an inspector when you aren't following the rules that you wrote yourself.

Next month, I'll discuss the State and Medicare inspections, and the licensing and credentialing process necessary to begin treating patients. One final note this month, to those of you who are e-mailing and calling me with questions. I'm not ignoring you. I will get to your questions. I promise. I'm answering them in the order I receive them. Thank you for being patient.

Larry Patterson, M.D., is practice owner, and Ray Mays is practice administrator of Eye Centers of Tennessee, a general ophthalmology practice serving 300,000 residents of middle and east Tennessee. You can reach Ray Mays at raym@ecotn.com.